Daily POEM: Virtual colonoscopy avoids the need for bowel prep

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Search EE+ Online POEMs Archive Weekly Podcast Share/Save Forward to a Friend Contact Us   Calculator of the Day Given Subcutaneous mass or nodule, what is the likelihood of ganglion cyst?		Virtual colonoscopy avoids the need for bowel prep Clinical Question Is computed tomographic colonography, without bowel preparation, as accurate as colonoscopy to detect relevant polyps? Bottom Line Computed tomographic (CT) colonography ("virtual colonoscopy") without prior laxative preparation, was as good as typical colonoscopy for ruling out clinically relevant (10 mm or larger) adenomatous polyps in patients undergoing screening. As one might expect, patients preferred going through a CT scanner without spending the previous evening in the bathroom to the normal process of bowel cleansing and conscious sedation as part of the colonoscopy experience. (LOE = 1b) Reference Zalis ME, Blake MA, Cai W, et al. Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults. A prospective evaluation. Ann Intern Med 2012;156(10):692-702. Study Design Cohort (prospective) Funding Industry + govt Setting Outpatient (specialty) Allocation Unknown Synopsis These investigators enrolled 605 adults who were at average to moderate risk for colon cancer and were eligible for screening colonoscopy. All patients underwent CT colonography without the usual laxative bowel preparation, instead participants swallowed a tracer that allowed a software program to subtract colon contents from the image. All patients, at another visit, also underwent colonoscopy following a typical bowel preparation using a cathartic. During this visit, the colonoscopist performed the examination, noting any polyps, and then consulted the results of the previous CT colonograph. If findings were different, the investigator confirmed the findings upon withdrawal of the scope. This second pass became the reference (gold) standard, allowing the investigators to determine the sensitivity of both types of examination. Polyp size was established using the CT colonography. CT colonograph was 91% sensitive (95% CI, 71% - 99%) and 95% specific (82% - 88%). Standard colonoscopy was 95% sensitive (77% - 100%) and 89% specific (86% - 91%). For this population, the negative predictive value for both tests was 100% (99% - 100%) for missing a clinically significant adenomatous polyp. No surprise -- participants reported a more confortable experience with colonography. Allen F. Shaughnessy, PharmD Professor of Family Medicine Tufts University Boston, MA
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